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WO2019188956A1 - Effecteur terminal permettant la préhension de tissu et l'application d'un rayonnement plasma à un tissu, et système endoscopique comprenant ledit effecteur terminal - Google Patents

Effecteur terminal permettant la préhension de tissu et l'application d'un rayonnement plasma à un tissu, et système endoscopique comprenant ledit effecteur terminal Download PDF

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Publication number
WO2019188956A1
WO2019188956A1 PCT/JP2019/012448 JP2019012448W WO2019188956A1 WO 2019188956 A1 WO2019188956 A1 WO 2019188956A1 JP 2019012448 W JP2019012448 W JP 2019012448W WO 2019188956 A1 WO2019188956 A1 WO 2019188956A1
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WO
WIPO (PCT)
Prior art keywords
end effector
plasma
tissue
gas
grasping
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2019/012448
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English (en)
Japanese (ja)
Inventor
沖野　晃俊
秀一 宮原
浩明 川野
悠太 林
祐磨 末永
利寛 高松
学 黒澤
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Tokyo Institute of Technology NUC
Original Assignee
Tokyo Institute of Technology NUC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Tokyo Institute of Technology NUC filed Critical Tokyo Institute of Technology NUC
Priority to US17/041,156 priority Critical patent/US20210007788A1/en
Publication of WO2019188956A1 publication Critical patent/WO2019188956A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/015—Control of fluid supply or evacuation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/042—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating using additional gas becoming plasma
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A61B18/085—Forceps, scissors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B23/00—Telescopes, e.g. binoculars; Periscopes; Instruments for viewing the inside of hollow bodies; Viewfinders; Optical aiming or sighting devices
    • G02B23/24—Instruments or systems for viewing the inside of hollow bodies, e.g. fibrescopes
    • H—ELECTRICITY
    • H05—ELECTRIC TECHNIQUES NOT OTHERWISE PROVIDED FOR
    • H05H—PLASMA TECHNIQUE; PRODUCTION OF ACCELERATED ELECTRICALLY-CHARGED PARTICLES OR OF NEUTRONS; PRODUCTION OR ACCELERATION OF NEUTRAL MOLECULAR OR ATOMIC BEAMS
    • H05H1/00—Generating plasma; Handling plasma
    • H05H1/24—Generating plasma
    • H05H1/26—Plasma torches
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A61B2018/00583—Coblation, i.e. ablation using a cold plasma
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595—Cauterization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes

Definitions

  • the present invention relates to an end effector that enables grasping of tissue and plasma irradiation to the tissue, and an endoscope system including the end effector.
  • low-temperature plasma generator for example, see Non-Patent Document 1.
  • low-temperature plasma can obtain effects such as sterilization, blood coagulation (hemostasis), and wound healing in the medical field.
  • low temperature plasma is expected to be applied to hemostasis because blood can be coagulated in a short time without damaging the tissue.
  • Mynavi Co., Ltd. “Developing an atmospheric pressure plasma device capable of precisely controlling temperature at -90 to + 150 ° C, such as Tokyo Institute of Technology”, [online], [searched on January 31, 2018], Internet ⁇ URL: https : //news.mynavi.jp/article/20111026-a080/>
  • low-temperature plasma has a limited hemostatic effect on exposed blood vessels and ejection bleeding.
  • the present invention has been made in view of the above-described problems, and an object thereof is to provide an improved hemostatic end effector and an endoscope system including the end effector.
  • the end effector of the present invention includes a grasping member for grasping a tissue and a plasma generation mechanism capable of generating plasma.
  • the end effector further includes a hinge portion, the gripping member and the plasma generation mechanism are connected to each other at the hinge portion, and the gripping member includes the hinge portion. You may be comprised so that rotation centering is possible.
  • the end effector further includes a connection portion connectable with a traction means capable of traction of the plasma generation mechanism, and the connected traction means is operated to operate the end effector. Grasping of the tissue with a grasping member may be achieved.
  • the connecting portion may be configured so that the traction means can be attached and detached.
  • the gripping member may be configured to be electrically controlled.
  • the plasma generation mechanism may be configured to irradiate the plasma to a position where the gripping member grips the tissue.
  • the gripping member may include a plurality of gripping pieces.
  • the plasma generation mechanism has a housing shape having a hollow portion, and the housing includes a first electrode and a second electrode different from the first electrode.
  • the plasma generation mechanism may convert the gas passing through the hollow portion into plasma by a discharge between the first electrode and the second electrode.
  • an endoscope system of the present invention includes the end effector according to any one of claims 1 to 8.
  • the endoscope system is a gas supply source capable of supplying a gas that is converted into plasma by the plasma generation mechanism, and the gas supply source includes one or more types of gas supply sources. You may further provide the gas supply source which can supply gas, the power supply which can be switched between several modes, and the traction means which can be connected to the said connection part of the said end effector.
  • the plurality of modes may include at least two of a low temperature plasma mode, an APC (argon plasma solidification method) mode, and a high frequency solidification mode.
  • APC argon plasma solidification method
  • the endoscope system may further include a pulse gas system for enabling a gas to be converted into plasma to be supplied to the hollow portion in a pulse shape.
  • FIG. 1 shows a schematic diagram of an example of an endoscope system 10 including the end effector of the present invention.
  • FIG. 2 is a cross-sectional view showing an example of the configuration of the end effector 100 of the present invention.
  • FIG. 3 is a cross-sectional view showing a changed state of the end effector 100 of FIG.
  • distal refers to a portion farther from the user (operator), and the term “proximal” refers to a portion closer to the user.
  • proximal refers to a portion closer to the user.
  • about refers to a range of ⁇ 10% of the following number.
  • the present invention features an end effector that enables grasping of tissue and plasma irradiation of the tissue, and an endoscope system including the end effector and an operation unit.
  • the operation of the end effector for example, tissue grasping, tissue plasma irradiation
  • a power source having one or more modes and a supply source for supplying a supply can be connected to the operation unit as necessary.
  • the power supply may have multiple modes.
  • the multiple modes are two of a low temperature plasma mode, an APC (argon plasma solidification) mode, a radio frequency solidification mode, preferably 3
  • the present invention is not limited to this.
  • An example of the supply source is a gas supply source for supplying a gas to be plasmatized.
  • the gas is supplied from the gas supply source to the end effector through the operation unit.
  • the type of gas supplied can vary depending on one or more modes of the power source.
  • the gas supplied to the end effector is turned into plasma in the end effector and irradiated to the tissue.
  • the gas supply source may comprise a pulse gas system to allow the gas to be supplied in pulses.
  • the pulse gas system can clarify the target of hemostasis by firing the gas in pulses.
  • the tissue is treated (for example, hemostasis, ligation).
  • FIG. 1 shows a schematic diagram of an example of an endoscope system 10 including an end effector of the present invention.
  • the endoscope system 10 includes an insertion unit 11, an operation unit 12 connected to the proximal end of the insertion unit 11, a power source 13 and a gas supply source 14 connected to the operation unit 12.
  • the gas supply source 14 is for supplying a gas to be converted into plasma. As shown in FIG. 1, the gas supply source 14 is mutually connected to the operation unit 12, and thereby supplies gas to the operation unit 12 and eventually to the insertion unit 11.
  • the gas supply source 14 includes a gas storage unit 14a for storing gas, and a pulse gas system 14b for enabling gas to be supplied in a pulse shape.
  • the gas storage unit 14a is configured to be capable of storing a plurality of types of gases and extracting the stored gas.
  • the aspect of storage of multiple types of gas is arbitrary.
  • a plurality of types of gas may be stored by providing a plurality of gas tanks capable of storing one type of gas, and each interior of a housing having a plurality of partitioned spaces inside.
  • Various types of gas may be stored in the space, or a plurality of types of gas may be stored so that various types of gas can be extracted as needed in a state where a plurality of types of gas are mixed. You may do it.
  • the gas stored in the gas storage part 14a is argon, a carbon dioxide, oxygen, nitrogen, helium, and air, for example, it is not limited to these.
  • the pulse gas system 14b is for enabling the plasmaized gas supplied from the gas supply source 14 to the operation unit 12 or the insertion unit 11 to be supplied in pulses.
  • the pulse gas system 14b is configured so as to be able to apply a high-speed air flow having a predetermined pressure to the gas to be converted into plasma at a constant time interval, whereby a pulse to the operation unit 12 or the insertion unit 11 is provided. Allows the supply of gaseous gases.
  • the pulse gas system 14b is configured to be able to add a high-speed air stream to the gas to be plasmatized. The pressure of the air flow applied by the pulse gas system 14b, the addition interval, and the number of irradiations can be appropriately adjusted according to the conditions required for the tissue treatment.
  • the pressure of the airflow is, for example, about 0.3 to about 0.9 MPa.
  • the addition interval is, for example, about 0.1 to about 5 seconds.
  • the number of times of irradiation is, for example, about 5 to about 20 times.
  • the high-speed airflow may be applied 5 times, 10 times, or 20 times under the condition of a high-speed airflow with a pressure of 0.3 MPa at intervals of 0.1 seconds.
  • the high-speed airflow may be applied 5 times, 10 times, or 20 times under the condition of a high-speed airflow at a pressure of 0.6 MPa at intervals of 0.1 seconds.
  • the high-speed air flow may be applied 5 times, 10 times, or 20 times under the condition of a high-speed air flow with a pressure of 0.9 MPa at intervals of 0.1 seconds.
  • the present invention is not limited to these. In this way, by pulsing the plasma gas into the affected area and irradiating the affected area with the plasma, it is possible for the pulsed plasma to treat the affected area while the high-speed air current blows away disturbing blood and foreign matters. Therefore, irradiation with pulsed gas contributes to improved visibility of the affected area and high-speed hemostasis.
  • the number of gas supply sources 14 is one, but the present invention is not limited to this.
  • the number of the gas supply sources 14 is an arbitrary number of 1 or more.
  • a carbon dioxide supply source for storing and supplying only carbon dioxide and an argon supply source for storing and supplying only argon may be connected to the operation unit 12.
  • a supply source for supplying a supply other than gas may be further connected to the operation unit 12.
  • the supply supplied from the supply source may be, for example, illumination light that illuminates the treatment site or the periphery of the examination site, or guides the irradiation position of the plasma irradiated from the end effector. It may be a laser light source, or may be cooling water for cooling a treatment site or an endoscope.
  • the power source 13 is for supplying necessary power to the operation unit 12 and to the device built in the insertion unit 11.
  • the power supply 13 is configured to be switchable between a plurality of modes.
  • the power source 13 can be switched between a low temperature plasma mode 13a, an APC (argon plasma coagulation method) mode 13b, and a high frequency coagulation mode 13c, but the present invention is not limited to this.
  • switching between the low temperature plasma mode 13a and the APC (argon plasma coagulation method) mode 13b may be used, or switching between the low temperature plasma mode 13a and the high frequency coagulation mode 13c may be performed.
  • switching between APC (argon plasma coagulation method) mode 13b and high-frequency coagulation mode 13c may be used.
  • the low temperature plasma mode 13a is a mode for performing plasma irradiation at a low temperature (eg, about ⁇ 90 to about 160 ° C., more preferably about 40 to about 100 ° C. Use of plasma at 40 ° C. to 100 ° C. In addition to the chemical blood coagulation effect, it is preferable in that dehydration of blood or the like by heat can be performed while reducing thermal damage, by switching the power supply 13 to the low temperature plasma mode 13a, as will be described later.
  • the end effector 100 can convert the gas supplied from the gas supply source 14 into plasma at a low temperature and irradiate the affected part with plasma at a low temperature, and an example of the gas converted into plasma at a low temperature is stored in the gas storage unit 14a. As mentioned above as an example of gas, cold plasma is highly safe and has a high hemostatic effect against spilled bleeding However, the effect is limited for hemostasis of such gushing hemorrhage or exposure vessel.
  • the APC mode 13b is a mode for realizing treatment of the affected area by APC.
  • the power supply 13 applies a high-frequency current to the argon supplied from the gas supply source 14. This makes it possible to treat the affected area with APC.
  • APC has a high hemostatic effect against spilled bleeding. This is because APC is not a local ablation with a small ablation surface area, but treats oozing bleeding by cauterizing a large area with a large ablation surface area by plasma gas.
  • APC does not have a gripping structure that can seal the bleeding part of a blood vessel by heat denaturation, the hemostatic effect on ejection bleeding and exposed blood vessels is low.
  • the high-frequency coagulation mode 13c is a mode for realizing cauterization of the affected area using a high-frequency current.
  • a high-frequency current is applied to the end effector 100 and flows to the affected area, and the affected area can be coagulated with heat from the high-frequency current.
  • the frequency of the high frequency applied in the high frequency coagulation mode 13c may be, for example, 10 kHz to 5 MHz, preferably 10 kHz to 1 MHz, and more preferably 10 kHz to 500 kHz.
  • High-frequency coagulation has a high hemostatic effect against various states of bleeding such as efferent bleeding. However, it can cause tissue damage.
  • the operation unit 12 is for operating the insertion unit 11 and a device built in the insertion unit 11. As shown in FIG. 1, the operation unit 12 is connected to a supply source 13 and is configured to be able to control the supply amount of the supply supplied from the operation unit 12. Further, as shown in FIG. 1, the operation unit 12 is connected to a power supply 13 and is configured to be able to control switching between a plurality of modes of the power supply 13.
  • the insertion part 11 is a part inserted into the body.
  • the insertion unit 11 is controlled by the operation unit 12 and is configured to be able to bend so as to change the direction of the insertion unit 11 in accordance with an input from the operation unit 12.
  • the insertion portion 11 includes an end effector 100 that can project from the distal end portion 11 ′ of the insertion portion 11.
  • the size of the diameter of the insertion portion 11 can be any size. It is preferable to be as small as possible so that it can operate even in a minute space (for example, in the intestine or digestive organs). For example, when the endoscope 10 is an endoscope for large intestine, it is about 13 mm, but the present invention is not limited to this. Also, the diameter of the end effector can be any size.
  • the end effector is provided in the forceps channel of the endoscope for the large intestine, it is about 3 mm, but the present invention is not limited to this.
  • the insertion portion 11 includes a forceps channel, and the end effector 100 can pass through the forceps channel depending on the situation and protrude from the open end of the forceps channel on the distal end portion 11 ′ of the insertion portion 11. It is configured. For example, it projects when the treatment site is treated by the end effector, and is housed in the insertion portion 11 when the endoscope 10 itself is moved.
  • the device built in the insertion unit 11 may include, for example, an imaging unit (for example, a camera lens) and an illumination device (for example, a light) in addition to the end effector 100. There may be one device built into the insertion unit 11 or a plurality of devices. Furthermore, a nozzle for discharging the supply from the supply source 13 can be provided in the insertion part 11.
  • FIG. 2 is a cross-sectional view showing an example of the configuration of the end effector 100 of the present invention.
  • the end effector 100 of the present invention includes a grasping member 110 for grasping a tissue and a plasma generation mechanism 120 capable of generating plasma.
  • the gripping member 110 includes a first gripping piece 110a and a second gripping piece 110b.
  • the gripping member 110 shown in FIG. 2 is in an open state. Tissue grasping is achieved by the cooperation of the first grasping piece 110a and the second grasping piece 110b.
  • An example of the gripping member 110 is a medical clip, but is not limited thereto.
  • the gripping member 110 may include a protrusion 111a on the first grip piece 110a and a protrusion 111b on the second grip piece 110b.
  • the protrusion 111a and the protrusion 111b are used to maintain the closed state of the gripping member 110, as will be described in more detail later.
  • the protruding portion 111 a and the protruding portion 111 b serve as a stopper mechanism so that the end effector 100 is not excessively drawn into the insertion portion 11.
  • the plasma generation mechanism 120 has a housing shape having a hollow portion.
  • the hollow portion is defined between an emission hole 130 on the distal end of the plasma generation mechanism 120 and an inflow hole 140 on the proximal end of the plasma generation mechanism 120.
  • the gas supplied from the gas supply source 14 enters the hollow portion from the inflow hole 140 and is discharged from the discharge hole 130 through the hollow portion.
  • a high frequency may generate
  • the part which does not intend a high frequency to flow is insulative (for example, you may comprise with an insulating member, resin or (It may be coated with an insulating member such as ceramic).
  • the plasma generation mechanism 120 includes a first electrode 150a and a second electrode 150b as means for generating plasma.
  • the first electrode 150a and the second electrode 150b are arranged along the inner wall of the hollow portion so as not to obstruct the gas flow.
  • the first electrode 150a and the second electrode 150b are buried in the plasma generation mechanism 120 along the inner wall of the hollow portion.
  • the first electrode 150a is a grounded electrode
  • the second electrode 150b is a high-voltage electrode having a higher voltage than the first electrode 150a.
  • the first electrode 150a may be an electrode having a lower voltage than the second electrode 150b.
  • a discharge is generated between the first electrode 150a and the second electrode 150b. Accordingly, the gas that has entered through the inflow hole 140 passes through the hollow portion of the end effector 100 and is discharged between the first electrode 150a and the second electrode 150b by the discharge between the first electrode 150a and the second electrode 150b. And is emitted from the discharge hole 130. Thereby, plasma is injected from the discharge hole 130, and the blood coagulation and sterilization effects are brought about by irradiating the irradiation target (for example, bleeding site) with the plasma.
  • the irradiation target for example, bleeding site
  • the flow rate of the plasma generated by the discharge between the first electrode 150a and the second electrode 150b is greater than about 0 to about 15 L / min, more preferably greater than about 0 to about 3 L / min. is there.
  • a low dose such as greater than about 0 to about 3 L / min, may be preferred in that the incidence of submucosal emphysema is reduced.
  • the inflow hole 140 and the discharge hole 130 have arbitrary shapes as long as plasma can pass through. For example, the shape of the inflow hole 140 and the discharge hole 130 may be a circle, a rectangle, or a polygon.
  • the first electrode 150a and the second electrode 150b may be used in combination in the low temperature plasma mode, the APC mode, and the high frequency coagulation mode, or different electrodes may be used in each mode.
  • this invention is not limited to this.
  • a bipolar type configuration in which a high voltage is applied to a pair of electrodes (that is, a first electrode and a second electrode) while a plasma generation mechanism is grounded or a plasma is generated by applying a low voltage.
  • a monopolar type configuration using a counter electrode plate may be realized by applying a high frequency to only a pair of electrodes while leaving the plasma generation mechanism not connected to a circuit.
  • the bipolar type configuration and the monopolar type configuration may be switchable by enabling switching of the plasma generation mechanism between ground and low voltage or not connected to the circuit.
  • the end effector 100 further includes a hinge part 160.
  • the hinge part 160 is provided in the plasma generation mechanism 120, and the hinge part 160 includes a hinge part 160 a for connecting the grip piece 110 a to the plasma generation mechanism 120 and a grip piece 110 b. And a hinge part 160b for connecting to the plasma generation mechanism 120.
  • the grip piece 110a is configured to be rotatable about the hinge portion 160a
  • the grip piece 110b is configured to be rotatable about the hinge portion 160b. Accordingly, the gripping member 110 can achieve opening and closing of the gripping member 110 by a rotational motion around the hinge portion 160.
  • the endoscope system 10 further includes traction means 170 capable of traction of the plasma generation mechanism 120, and the traction means 170 and the end effector 100 are configured to be connected to each other. That is, the end effector 100 serves as a connection part with the traction means 170. Further, the end effector 100 is configured to be detachable from the pulling means 170.
  • the traction means 170 is provided with a convex portion at the distal end of the traction means 170, and the convex portion and the concave portion provided in the end effector 100 are fitted to the end effector 100. It is connected.
  • the fitting strength between the convex portion of the pulling means 170 and the concave portion of the end effector is set lower than the fitting strength between a concave portion 181 of the lock mechanism 180 described later and the protruding portions 111a and 111b of the gripping member 110.
  • the pulling means 170 pulls the end effector 100 in the direction in which it is pulled into the insertion portion 11 with a force equal to or greater than the fitting strength between the protrusion of the pulling means 170 and the recess of the end effector 100, thereby And the recess of the end effector 100 are disengaged and can be detached from the end effector 100.
  • the endoscope system 10 further includes a lock mechanism 180.
  • the locking mechanism 180 is connected to the distal end 11 ′ of the insertion portion 11.
  • the locking mechanism 180 includes a recess 181, and the recess 181 is the distal end of the insertion portion 11. It is connected to the distal end portion 11 ′ of the insertion portion 11 by fitting with a convex portion arranged at 11 ′.
  • the fitting strength between the convex portion of the distal end portion 11 ′ of the insertion portion and the concave portion 181 of the locking mechanism 180 is the fitting strength between the concave portion 182 of the locking mechanism 180 described later and the protruding portions 111 a and 111 b of the gripping member 110.
  • the fitting strength between the convex portion of the pulling means 170 and the concave portion of the end effector 100 is set to be approximately the same.
  • the insertion part 11 is pulled in the direction in which the insertion part is drawn into the insertion part 11 with a force equal to or higher than the fitting strength between the convex part of the distal end part 11 ′ of the insertion part and the concave part 181 of the lock mechanism 180.
  • the insertion of the convex portion and the concave portion is released and the insertion portion 11 can be detached from the lock mechanism 180.
  • the lock mechanism 180 is configured to be able to maintain the closed state of the gripping member 110.
  • the lock mechanism 180 includes a recess 182 on the inner surface of the lock mechanism 180, and the protrusion 111 a and the protrusion 111 b are engaged with the recess 182, thereby rotating the gripping member 110. Is fixed, and the closed state of the gripping member 110 is maintained.
  • the gripping member 110 is in an open state as shown in FIG. 2 in a normal state by a force such as a tension spring (not shown).
  • a force such as a tension spring (not shown).
  • the pulling means 170 is pulled in the direction in which the end effector 100 is pulled into the insertion portion 11 in the open state, the end effector 100 starts to move toward the inside of the insertion portion 11 and pulls the pulling means 170 in the same direction.
  • the gripping member 110 physically contacts the distal end 11 ′ of the insert 11.
  • the grasping member 110 can rotate around the hinge portion 160 and can grasp the tissue by shifting from the open state to the closed state.
  • the gripping member 110 is opened in a normal state by a spring or the like and the gripping member 110 is closed by the movement of the traction means has been described, but the present invention is not limited to this.
  • the gripping member 110 may be closed in a normal state by a force such as a compression spring, and the gripping member 110 may be opened by the movement of the traction means.
  • the grasping member 110 Since it is possible to perform hemostasis treatment with plasma while directly grasping blood vessels and mucous membranes by the grasping member 110, it is effective for ejection bleeding and exposed blood vessels, which have been limited in hemostasis effect with conventional plasma. Can stop bleeding. Further, since the blood vessel or the like is directly gripped by the gripping member 110, it is possible to perform safe hemostasis with little tissue damage. Furthermore, by making the end effector 100 including the gripping member 110 detachable from the pulling means 170, the end effector 100 can be handled in the same manner as a hemostatic clip, and a reliable hemostatic effect can be obtained over a long period of time. It becomes possible. In particular, when hemostasis of a treatment portion having a high blood pressure is performed with plasma while being gripped by the gripping member 110, it may be preferable to use the APC mode 13B or the high-frequency coagulation mode 13C.
  • FIG. 3 is a cross-sectional view showing a changed state of the end effector 100 of FIG.
  • FIG. 3 shows a state after the end effector 100 transitions from the open state to the closed state by the operator pulling the pulling means 170 in the direction in which the end effector 100 is pulled into the insertion portion 11.
  • the protruding portion 111 a and the protruding portion 111 b are engaged with the recessed portion 182 in the closed state of the gripping member 110.
  • the end effector 100 is not pulled into the inner side of the insertion portion 11 from the position shown in FIG. 3, and the gripping member 110 does not shift to the open state.
  • the operator further pulls the pulling means 170 from the state shown in FIG.
  • the pulling means 170 is more than the fitting strength between the protrusions 111 a and 111 b and the recess 182. Since the fitting strength between the convex portion of this end portion and the concave portion of the end effector 100 and the fitting strength between the convex portion of the distal end portion 11 ′ of the insertion portion 11 and the concave portion 181 of the lock mechanism 180 are lower, the traction means 170 The distal end portion 11 ′ of the insertion portion 11 is detached from the lock mechanism 180 while being detached from the end effector 100. As a result, the end effector 100 maintained in the closed state by the lock mechanism 180 can be used alone. Therefore, as described above, the end effector 100 can be handled in the same manner as the hemostatic clip.
  • the plasma generation mechanism 120 has a position where the grasping member 110 grasps tissue (that is, the distal end of the first grasping piece 110a and the distal end of the second grasping piece 110b). Are arranged so that the plasma can be irradiated to the positions close to each other. That is, the end effector 100 can irradiate the tissue with the plasma by the plasma generation mechanism 120 in a state where the tissue is grasped using the grasping member 110, and can treat the tissue. In addition, by setting the position of the discharge hole 130 so that the plasma is irradiated toward the position where the gripping member 110 grips the tissue, the gripping member 110 serves as a guide mechanism that indicates the plasma irradiation direction.
  • the end effector 100 or the endoscope system 10 with a laser light source for indicating the plasma irradiation direction and irradiation position, the plasma irradiation position can be visualized, and the plasma irradiation position can be positioned more accurately. It becomes possible.
  • each of the proximal end of the end effector 100 and the traction means 170 may have a corresponding thread, or a magnet that allows the end effector 100 and the traction means 170 to be detachably connected. It may be provided. Further, in the embodiment shown in FIGS.
  • connection mode in which the distal end portion 11 ′ of the insertion portion 11 is fitted to the proximal end portion of the locking mechanism 180 has been described. It is not limited.
  • the manner of connection between the distal end portion 11 ′ of the insertion portion 11 and the locking mechanism 180 is also arbitrary as long as it is detachable from each other.
  • each of the distal end portion 11 ′ and the locking mechanism 180 of the insertion portion 11 may have a corresponding thread, or the distal end portion 11 ′ and the locking mechanism 180 are detachably connected.
  • An enabling magnet may be provided.
  • the gripping member 110 is kept closed by the protrusion 111a, the protrusion 111b, and the recess 182.
  • the closed state of the gripping member 110 may be maintained by any means capable of maintaining the closed state of the gripping member 110.
  • the gripping pieces 110a and 110b may include magnets (not shown), and the closed state may be maintained when the gripping pieces 110a and 110b are closed within a predetermined range by the force of the magnets.
  • the number of gripping pieces is two, but the present invention is not limited to this.
  • the number of gripping pieces is an arbitrary number of 2 or more.
  • the grip member 110 may include three grip pieces or four grip pieces.
  • the gripping member 110 is opened and closed by physical contact, but the configuration of the gripping member 110 is not limited to this.
  • the gripping member 110 may be configured such that opening / closing of the gripping member 110 can be electrically controlled by the operation unit 12. Accordingly, the operator can open and close the gripping member 110 without pulling the end effector 100 to open and close the gripping member 110.
  • plasma irradiation to the tissue, tissue grasping by the grasping member 110, switching between the low-temperature plasma mode, the APC mode, and the high-frequency coagulation mode can be realized by one end effector of the present invention.
  • a hemostatic device for example, a gripping member, an APC device, a high-frequency coagulation device, or a low-temperature plasma device
  • various hemostasis methods can be selected by switching modes depending on the situation without having to bother to replace the hemostasis instrument. Therefore, it is significant in that safe and secure early treatment can be performed accurately.
  • the endoscope system 10 of the present invention capable of handling the low temperature plasma and the grasping member 110 is significant in that both the irradiation of the low temperature plasma and the grasping of the tissue by the grasping member have high safety. I can say that.
  • the present invention is useful for providing an improved end effector for hemostasis, an endoscope system including the end effector, and the like.

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Abstract

La présente invention concerne un effecteur terminal permettant la préhension d'un tissu et l'application d'un rayonnement plasma à un tissu. L'effecteur terminal selon l'invention comprend : un élément de préhension pour saisir un tissu ; et un mécanisme de génération de plasma capable de générer un plasma. Un moyen de traction est relié au mécanisme de génération de plasma, et par actionnement du moyen de traction relié, la préhension du tissu par le moyen de préhension est réalisée. Le moyen de génération de plasma est configuré de façon à permettre qu'un rayonnement plasma soit appliqué à la position où l'élément de préhension saisit le tissu.
PCT/JP2019/012448 2018-03-26 2019-03-25 Effecteur terminal permettant la préhension de tissu et l'application d'un rayonnement plasma à un tissu, et système endoscopique comprenant ledit effecteur terminal Ceased WO2019188956A1 (fr)

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US17/041,156 US20210007788A1 (en) 2018-03-26 2019-03-25 End effector enabling grasping of tissue and plasma radiation to tissue, and endoscopic system comprising said end effector

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JP2018057947A JP7061788B2 (ja) 2018-03-26 2018-03-26 組織の把持と組織へのプラズマ照射とを可能にするエンドエフェクタおよびそのエンドエフェクタを備える内視鏡システム
JP2018-057947 2018-03-26

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TWI702934B (zh) * 2019-10-09 2020-09-01 明志科技大學 具內視功能之低溫大氣電漿裝置
CN114587446A (zh) * 2020-12-04 2022-06-07 杭州安杰思医学科技股份有限公司 一种端部执行器械及操作方法

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JP7443171B2 (ja) * 2020-06-30 2024-03-05 日本特殊陶業株式会社 先端デバイス

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US20100089742A1 (en) * 2007-08-06 2010-04-15 Plasma Surgical Investment Limited Pulsed plasma device and method for generating pulsed plasma
US20130090642A1 (en) * 2011-07-06 2013-04-11 Arqos Surgical, Inc. Laparscopic tissue morcellator systems and methods
JP2013236884A (ja) * 2012-05-11 2013-11-28 Takeshi Ohira 難治性出血を止血する通常開腹術および内視鏡下手術用止血治具

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TWI702934B (zh) * 2019-10-09 2020-09-01 明志科技大學 具內視功能之低溫大氣電漿裝置
CN114587446A (zh) * 2020-12-04 2022-06-07 杭州安杰思医学科技股份有限公司 一种端部执行器械及操作方法
CN114587446B (zh) * 2020-12-04 2023-09-29 杭州安杰思医学科技股份有限公司 一种端部执行器械及操作方法

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